Provider Demographics
NPI:1497127278
Name:FERNANDEZ, XIOMARA ALEXIS (R-PAC)
Entity Type:Individual
Prefix:MS
First Name:XIOMARA
Middle Name:ALEXIS
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:R-PAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 W PORTAL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1305
Practice Address - Country:US
Practice Address - Phone:415-821-8798
Practice Address - Fax:415-242-6244
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY019239363A00000X
CA58185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant